Female genital mutilation: the case for a national action plan - Home Affairs Committee Contents

1 Introduction

1. The World Health Organization (WHO)
defines female genital mutilation (FGM) as "all procedures
involving the partial or total removal of the external female
genitalia or other injury to the female genital organs for non-medical
reasons".[1] It has
four classifications:

· Type
1 (clitoridectomy), which
involves partial or total removal of the clitoris and, in rare
cases, only the prepuce;

· Type
2 (excision), which involves
partial or total removal of the clitoris and the labia minora,
with or without excision of the labia majora;

· Type
3 (infibulation), which involves
narrowing of the vaginal opening through the creation of a covering
seal, which is formed by cutting and repositioning the inner or
outer labia, with or without removal of the clitoris; and

· Type
4 (other), which comprises
all other harmful procedures to the female genitalia for non-medical
purposes, such as pricking, piercing or incision of the clitoris
and/or the labia; stretching of the clitoris and/or labia; and
cauterisation or burning of the clitoris and surrounding tissues.

2. FGM is usually carried out on girls
between infancy and the age of 15, with the majority of cases
occurring between the ages of five and eight. It is also occasionally
carried out on adult women, for example, reinfibulation following
childbirth, or where a woman is forced into the procedure by her
husband after marriage. Though in some countries it is more likely
to be carried out by a health professional, it is commonly performed
by a traditional practitioner with no formal medical training,
without anaesthetics or antisepsis, using knives, scissors, scalpels,
pieces of glass, or razor blades.[2]
Often the girl is forcibly restrained. Leyla Hussein, a survivor
and campaigner, described to us her experience of being cut when
she was eight:

They brought this other man to hold
me down. I remember just feeling ashamed because they were seeing
my private parts. I think that is what I was worried about more
than anything. He said, "We are going to give you an injection
and everything will be fine. You won't feel a thing". I felt
everything. I felt the injection. I felt being cut. I felt being
sewn.[3]

3. For girls and women who undergo FGM
the health consequences are often devastating. The immediate effects
include severe pain, bleeding, shock, urine retention, infections,
injury to neighbouring organs, and sometimes death from uncontrolled
bleeding. Longer-term complications arising from Type 1 and 2
FGM include failure of the wound to heal, abscess formation, urinary
tract infection, dermoid cysts, vulval adhesions, neuromas, and
painful sexual intercourse. Type 3 FGM can result in any of the
above complications, as well as reproductive tract infections,
which can lead to pelvic inflammatory disease, dysmenorrhoea,
chronic urinary tract obstruction, and urinary incontinence, as
well as a range of other severe complications.[4]
In addition, many women and girls experience long-term mental
health problems, such as depression and post-traumatic stress.

4. The United Nations Children's Fund,
UNICEF, estimates that 125 million women and girls worldwide have
undergone FGM, the majority in a belt of 29 African countries
that stretches from the Atlantic to the Horn of Africa. In Egypt
alone, 27.2 million women and girls have undergone FGM, with 23.8
million in Ethiopia, and 19.9 million in Nigeria.[5]
Prevalence rates vary significantly. In Somalia, Guinea, Djibouti
and Egypt, for example, more than 90 per cent of the female population
aged between 15 and 49 have been cut, whereas in Niger, Cameroon
and Uganda it is less than two per cent. Prevalence may also vary
greatly within countries, and can be more closely associated with
particular ethnic groups. Overall, it is believed that up to 3 million
girls are subjected to FGM every year.

5. The origins of FGM are complex and
go back thousands of years. It is a cultural practice, which does
not have any basis in religion, although there is a commonly-held
misconception that it is a religious requirement. In practising
groups it is rooted in patriarchy, and is seen as a rite of passage
to adulthood and a prerequisite for marriage. For some African
women, marriage and reproduction are the only means of ensuring
economic security and social status. Without undergoing FGM, a
woman may be denied the right of marriage, with the potential
consequence of casting her out from society. The Hawa Trust, an
organisation which works with local communities in Hackney to
tackle FGM, told us:

The young uncircumcised girl is
still considered today as a second-class citizen, impure, a bilekoro,
according to a typical expression in Mali and Guinea. Such a young
girl can neither marry nor even be allowed to prepare the family
meal until she agrees to be circumcised.[6]

6. Many adherents to the practice believe
that FGM has an important role in preserving virginity and chastity
before marriage. After marriage, it is assumed to ensure the faithfulness
of the woman to her husband. Other commonly-held, erroneous beliefs
include the suggestions that the procedure enhances fertility,
increases sexual pleasure for the man, and ensures the health
of babies. Notwithstanding such mistaken beliefs, families within
practising communities often feel a strong sense of obligation
to conform, fearing that failure to do so will lead to social
exclusion, ridicule, and an inability to find a suitable marriage
partner for their daughters. In short, it is a powerful and deeply
rooted social norm founded on the subordination of women. As Nimco
Ali, a survivor and campaigner, told us:

It is about controlling women's
sexuality and women's aspirations to do anything. If a woman is
in pain [ ] and she is scared about what is going to happen
to her, then ultimately she is never going to attain her full
potential.[7]

7. Internationally, FGM is recognised
increasingly as a severe form of violence against women and girls.
This was also acknowledged in the overwhelming majority of evidence
received as part of our inquiry.[8]
The 1993 UN Declaration on the Elimination of Violence against
Women defines FGM as a form of violence against women. Article
5 of the Protocol to the African Charter on Human and Peoples'
Rights on the Rights of Women in Africa requires states to prohibit
traditional practices that are harmful to women, including FGM,
and to take all necessary measures, legal or otherwise, to protect
women from FGM. In recent years an increasing number of countries
have legislated against the practice. Indeed, FGM is now prohibited
to varying degrees in 24 out of 29 of the countries in Africa
and the Middle East where it is most prevalent.[9]
However, there is a growing consensus that legislation is just
one part of a range of interventions governments must undertake
to end the practice.

8. FGM is a severe form of gender-based
violence, and where it is carried out on a girl, it is an extreme
form of child abuse. Everyone who has a responsibility for safeguarding
children must view FGM in this way.

FGM in the UK

9. FGM has been a criminal offence in
the UK since 1985. Its existence in the UK is largely as a result
of migration from practising countries. Its prevalence has been
difficult to determine because of the hidden nature of the crime.
The most widely cited estimates are from a study published by
FORWARD UK in 2007.[10]
Using 2001 census data, this estimated that approximately 66,000
women between the ages of 15 and 49 in England and Wales had undergone
FGM. This figure includes women who were cut before entering the
country, and women who have been cut since becoming residents.
The study also estimated that at least 24,000 girls under the
age of 15 were at high risk or may have already undergone FGM,
Type 3. This included girls born abroad who had migrated to England
and Wales, and girls born here to mothers from practising countries.
In addition, the study estimated a further 9,000 girls were at
high risk or may have already undergone FGM, Type 2.

10. Because of increased migration from
practising countries, notably Somalia and the rest of the Horn
of Africa, as well as population growth over the last decade,
it is likely that the prevalence of FGM and the number of girls
at risk have increased significantly since the 2007 study.[11]
A more recent study using 2011 census data estimated that around
170,000 women and girls were living with FGM in the UK, and that
65,000 girls aged 13 and under were at risk of being cut.[12]
Leyla Hussein and Nimco Ali from the Daughters of Eve told us
they believed the true figure for the number of girls at risk
was likely to be more than triple that estimated in the 2007 study.[13]

11. There is also a lack of data on
the geographical spread of girls at risk of FGM. The 2007 study
found that, between 2001 and 2004, maternities to women who were
likely to have undergone FGM accounted for 6.3 per cent of maternities
in inner London and 4.6 per cent in outer London. In the London
boroughs of Southwark and Brent, almost one in ten maternities
were to women likely to have undergone FGM. Outside of London,
areas that had a prevalence of two per cent or more included Cardiff,
Manchester, Sheffield, Northampton, Birmingham, Oxford, Crawley,
Reading, Slough and Milton Keynes. Our written evidence also highlighted
Leeds and Bedford as areas with large potential at-risk groups.
The Agency for Culture and Change Management, a non-governmental
organisation, noted too that the Government's dispersal policy
will have created large migrant communities in small towns, some
of whom are from FGM-practising countries.[14]
Even then, as FORWARD argued, those at risk are not a homogenous
group, and include British citizens born in the UK, migrant groups,
asylum seekers, refugees and students from affected communities.[15]
There are also varying trends within communities. For example,
the Tackling FGM Initiative told us that dialogue on FGM within
the Somali community had resulted in support for the practice
waning amongst settled members in recent years.[16]

12. The paucity of data extends also
to where the cutting takes place. Anecdotal evidence suggests
it is common for girls subjected to FGM to be taken back to their
country of origin during the holidays to undergo the procedure.
But there is also evidence that FGM takes place in the UK.[17]
The Metropolitan Police, for example, told us information it had
gathered from communities suggested that cutters were operating
in London.[18] However,
there is no reliable information on the extent to which FGM is
taking place in this country as opposed to abroad. Furthermore,
FORWARD noted that community members reporting FGM were more likely
to say that it happened abroad before they became a British citizen
to avoid the risk of further investigation.[19]

13. The Home Office and the Metropolitan
Police are part-funding a new study into the prevalence of FGM
in England and Wales using data from the 2011 census, which will
update the figures in the 2007 study, and provide new estimates
broken down by local authority area. The results of this work
are expected this summer. In addition, earlier this year the Department
of Health announced that all acute hospitals would begin reporting
information about the prevalence of FGM within their patient population
each month from September 2014.[20]
The Parliamentary Under Secretary of State for Public Health told
us the new reporting arrangements would give, for the first time,
a clear picture of what is happening in the UK.[21]

14. Even conservative estimates of
the number of girls at risk of FGM indicate that it could be one
the most prevalent forms of severe physical child abuse in the
UK. In two London boroughs, for example, almost one in ten girls
are born to a woman who has undergone FGM, and are therefore at
risk of being cut themselves. Yet, apart from a small number of
high-level statistical analyses and anecdotal evidence, we have
very little information on the children who are most at risk,
and even the extent to which the cutting is occurring in this
country or by taking girls abroad. Meanwhile, as many as 170,000
women in the UK may already be living with the life-long consequences
of FGM. We welcome efforts by the Government and others to draw
a more accurate picture. However, even in the absence of precise
data, it is clear that the extent of the problem is very significant,
and therefore needs to be matched by a response by all those who
have a responsibility for safeguarding children that is similar
in scale.

Recent developments and our Report

15. Until recently, there has been relatively
little public awareness of FGM in the UK. In 2000 the All Party
Parliamentary Group (APPG) on Population, Development and Reproductive
Health made 35 recommendations in respect of legislation, education
policy, community-based work, and health strategy, though the
majority of these were never translated into policy action.[22]
In 2003 the law against FGM was strengthened by extending its
coverage and increasing the potential punishments, though until
2014 there had not been a single prosecution. In the last two
years there has been a significant increase in media and parliamentary
awareness of the issue. Campaigns by The Evening Standard, theGuardian, and TheTimes have created much greater public
awareness of FGM, highlighting gaps in the provision of services,
the lack of sufficient data, and the absence of any FGM-related
prosecutions. The APPG on FGM has also been successful in pushing
the issue up the political agenda.

16. Underpinning greater political and
media interest in FGM has been the tireless work and lobbying
of third sector groups such as Equality Now, Daughters of Eve,
FORWARD, Integrate Bristol, and others, as well as a small number
of health professionals who see day-to-day the consequences of
FGM. Efforts by these organisations and individuals have created
a step-change in awareness and finally forced the Government,
the Crown Prosecution Service, and others to strengthen their
response. Indeed, earlier this year the Prime Minister announced
that he will host a major event in July 2014 on tackling FGM,
as well as early and forced marriage. The summit will consider
the need for action both domestically and internationally.

17. Although it is outside the scope
of this inquiry, we appreciate that FGM is unlikely to end in
the UK before it is abandoned by practising communities in Africa.[23]
To help achieve this, the Department for International Development
has recently provided £35 million over five years to
support the Africa-led movement to end FGM.[24]
Whilst we welcome this funding we note, however, the conclusion
of the International Development Committee in 2013 that "the
UK's credibility in calling to end the practice overseas is undermined
by the failure to tackle the problem at home".[25]

18. Evidence we received from the Bar
Human Rights Committee and the Equality and Human Rights Commission
(EHRC) argued that the state has a duty of care to protect women
and girls from FGM.[26]
Furthermore, the failure of the state to do so represents a breach
of the UK's international law obligations under the Convention
on the Elimination of All Forms of Discrimination against Women
1979, and the UN Convention on the Rights of the Child 1984.[27]
The EHRC also told us the fact that FGM is prohibited by law is
not in itself sufficient to discharge the state's responsibilities.
A number of witnesses told us that a comprehensive national action
plan led by the Government was the only way to tackle FGM in the
UK effectively.[28] This
call has also received the backing of 109,000 people who have
signed the e-petition set up by Leyla Hussein and Efua Dorkenoo
calling on the Government to put in place such a plan.

19. The failure to respond adequately
to the growing prevalence of FGM in the UK over recent years has
likely resulted in the preventable mutilation of thousands of
girls to whom the state owed a duty of care. This is a national
scandal for which successive governments, politicians, the police,
health, education and social care sectors all share responsibility.
We pay tribute to the efforts of a small number of individuals
and organisations who have worked to raise public awareness of
FGM and the impact it has on those who have undergone the procedure.
Many of those campaigners who have spoken out have had to withstand
criticism and ostracism by those in their own communities who
do not wish to see an end to the practice. We also acknowledge
the work of the Evening Standard, The Guardian, and The Times
in raising public awareness of FGM in the last year. The Government
has started to take action, and we welcome the stated commitment
to end FGM in a generation. It must now implement a comprehensive
and fully-resourced national action plan for tackling FGM. The
plan should provide clear leadership and objectives, setting out
the standards expected of all relevant bodies, and to which they
will be held accountable. It should incorporate a number of interlinked
aspects, including:

· the achievement of successful
prosecutions for FGM;

· working with professionals
in the health, education, social care and other sectors to ensure
the safeguarding of at-risk girls;

· changes to the law on
FGM;

· improved working with
communities to abandon FGM; and

· better services for women
and girls living with FGM.

20. We consider each of these in
the subsequent chapters of this Report. Finally, we welcome the
Prime Minister's planned summit on FGM and forced marriage. We
urge him to consider the recommendations in this Report. We welcome
the fact that the summit will reflect the international dimension
of the problem, and we hope that the relevant heads of government
of affected states are invited to attend. We believe the Government
should aspire to the UK being a world leader in the policy response
to FGM.